CERTIFICATE OF INSURANCE (2)
-c ..~,' 1F
This is to certify that policies of insurance listed below have been issued to the insured named above ael~ iG~tt"t1it this time.
limits of liability in Thousands (000)
EACH
OCCURRENCE
THE VEGH~E AGENCY
Post Office Box 1560
Clearwater, FL 33517
COMPANIES AFFORDING COVERAGES
COMPANY A AEtna Insurance Company
LETTER
COMPANY B St. Paul Companies
LETTER
COMPANY C \l J;J)
LETTER t
COMPANY 0
LETTER
COMPANY E lU
LETTER
NAME AND ADDRESS OF INSURED
Palm Pavilion of Clearwat.er, Inc.
and the Four Suns, Inc.
10 Bay Esplanade
Clearwater Beach, FL
TYPE OF INSURANCE
POLICY
EXPIRATION DATE
POLICY NUMBER
GENERAL LIABILITY
A
r/l/79
I
I
CG 13 32 81
BODILY INJURY
[ $3 0 0 , 0 0 $
I
COMPREHENSIVE FORM
[XJ PREMISES-OPERATIONS
o EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
[XJ PRODUCTS/COMPLETED
OPERATIONS HAZARD
o CONTRACTUAL INSURANCE
o BROAD FORM f'ROPERTY
DAMAGE
o INDEPENDENT CONTRACTORS
[XJ PERSONAL INJURY
BODIL Y INJURy AND
PROPERTY DAMAGE
COMBINED
PROPERTY DAMAGE
$
100,00
PERSONAL INJURY
AUTOMOBILE LIABILITY
BODILY INJURY
(EACH PERSON)
BODILY INJURY
(EACH OCCURRENCE)
$250
$500
A
[XI COMPREH[N~;iVE-:
~WNED
[XI ,,,,,EU
g Nor,-OWNED
I
~/1/79
ICOR~'
CG 13 32 81
PflOPfRTY DAMAGE
ElO[JIL Y INJURY AND
F'ROPERTY DAMAGE
COMBINED
EXCESS LIABILITY
I
/1/79
EIODIL Y INJURY AND
PROPEflTY DAMAGE
COMBINED
B
!Xl UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
509XC09l7
A
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
/1/79
WC 67 90 71
DESCRIPTION, OF OPERATIONSfLOCATIONSNEHICLES
State of Florida
Additional Named Insured:
Howard G. Hamilton
Cancellation: Should any of the above desgibed policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail ~ days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER
City of Clearwater
Post Office Box 4748
Clearwater, FL 33518
Attn:
City Clerk